A Contemporary Phone-Based Cardiac Coaching Program: Evolution and Cross Cultural Utility

Background: The Hospital Admission Risk Program (HARP) Cardiac Coach Program at Royal Melbourne Hospital has evolved to include a Greek and Italian service, developed in response to the diverse local community and supported by evidence that Culturally and Linguistically Diverse (CALD) groups both perceive health and respond to health care services and information, differently. This paper aims to evaluate if a phone-based cardiac coaching program can be adapted to the Greek and Italian populations using the English cohort as a comparator. Methods: We retrospectively analysed cardiovascular risk profiles at recruitment into and at discharge from the program. Patients (n = 383) were recruited after an acute coronary event or intervention between June 2011 and June 2013. Recruitment was into the English (n = 301 patients (79%)) Greek (40 (10%)) or Italian (42 (11%)) model. Data was collected on demographic information and risk factor status at entry and discharge from the program: waist circumference, weight, height, lipid profile, HbA1C, smoking status and physical activity. A comparison of the proportion of patients meeting the defined targets across the English, Italian and Greek cohorts was performed, with multivariate logistic regression analysis applied to adjust for differences in baseline variables. Results: There were baseline differences in age, smoking history, total cholesterol and cholesterol fractions, diastolic blood pressure, weight and physical activity between the cohorts. At discharge, the proportion of patients meeting targets within each cohort were similar. Conclusion: A phone-based integrated disease management program can be adapted to CALD patients, achieving comparable outcomes as compared with an English-speaking cohort. Health services need to respond to their local needs and be flexible in program delivery in order to benefit as many patients as possible.